Gayathrie Devi, S (2013) Prospective analytical study on the medical termination of pregnancies in a tertiary care centre. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Medical termination of pregnancy (MTP) is defined as termination of pregnancy before the fetus becomes viable (<20 weeks). Unlike spontaneous abortion that occurs without any interventions, MTP is known to be induced either by medical or surgical interventions for various reasons based on social, eugenic, medical and humanitarian conditions (The MTP act of 1971). Conditions are as follows: 1. Social cause includes unintended pregnancies in low socioeconomic status, contraceptive/sterilisation failures1 and families not able to afford more children. 2. Medical where the continuation of pregnancy may endanger the life of the pregnant women2 or cause grave injury to her physical and mental health 3. Eugenic where the risk of child being born with physical and mental abnormalities. 4. Humanitarian where the pregnancy caused by rape. Various medical and surgical methods are available for MTP all over the country. More commonly, medical method involving induction of abortion with Mifepristone and Misoprostol and surgical method involving priming of cervix with misoprostol followed by manual vacuum aspiration or dilatation and curettage (D & C)/ Hysterotomy is under practice. These methods mainly depend on the gestational age of the pregnancy (first trimester and second trimester). Techniques for first trimester MTP includes menstrual regulation, vaccum aspiration, suction curettage and dilatation and curettage and techniques for second trimester includes intra amniotic instillation of saline, mannitol and prostaglandins (PG), extra amniotic instillation of PG, ethacrydine lactate / aspirotomy / hysterotomy /hysterectomy. AIMS & OBJECTIVE: 1. To know the incidence of Medical termination of pregnancies in a tertiary level hospital. 2. To study the reasons for seeking MTP. 3. To analyse the success of the method of Induction, Induction abortion interval, Adoption of family planning methods. 4. To study the morbidity of the woman who had undergone MTP. MATERIALS AND METHODS: This study was carried out in Govt. Rajaji Hospital, Madurai during the period of 12 months (one year) from September 2011 to August 2012. Of the 3518 patients attending the family planning OP 496 women seeked MTP. Among them every 5th woman was selected and thus 100 cases were included in this study. Inclusion Criteria: Pregnant women belonging to I and II trimester of pregnancy seeking MTP in family planning OP in Government Rajaji Hospital were included in the study. Exclusion Criteria: Pregnant women with H/o. threatened abortion, Missed abortion and incomplete abortion were excluded in this study. In this study social and obstetric parameters contributing to induced abortions were analysed. SUMMARY: Among 3518 patients who attended the family planning OP at government Rajaji Hospital between Sept 2011 and Aug 2012 every 5th patient was selected among 496 patients who seeked induced abortion and thus 100 cases were studied. Women in this study reported to belong to the low socioeconomic group. Rate of induced abortion was highest 70% among the age group 20-29 years9, the percentage of induced abortion was 42% among the third gravida and less with increasing parity. Most of the study people (62%) are from the rural areas. About 56% of them belonged to Nuclear family. 84% of the women were married and 16% were unmarried. Among the unmarried women majority of them were from the rural areas 68.7%, uneducated 75%, belonging to joint family 93.8% and most of them were in the age group 18-21 yr. 62% of the women were educated, 38% of them were illiterate. Majority of the study people 73% belonged to first trimester of pregnancy and among them 58% were in the gestational age of 8-12 wks. Percentage of second trimester abortion was 81.3% in unmarried and 16.7% among the married women. About 97% of the pregnancies were terminated by the surgical method and only 3% of cases had undergone medical abortion. D&C including check curettage in 79% of cases, MVA in 16%, hysterotomy in 2% cases. 73% of the case had an induction abortion interval of <12hr and 3% of cases >24 hrs. Among the reasons for MTP social causes contributed to 63% medical reasons 32% and Eugenic 5%. Among the women who underwent induced abortions 86.2% adopted TAT as the concurrent sterilisation 4.6% of the study people adopted laproscopic sterilisation. 9.1% of them accepted postabortal CuT insertion as the temporary contraceptive method. About 55.4% of women seeked induced abortion with two living children 21.7% seeked induced abortion with only one child. About 19.3% of the women had a last child 1yr back. 37.3% of the women had last child birth 3yr back. Only 20.5% of the women seeked MTP with only female children. 18.1% of women who underwent MTP were delivered by LSCS. Only 2% of the study people gave the H/o. intake of tablets over the counter35. There was no complication in this study. There were no morbidity and mortality among the study people. CONCLUSION: This study analysed the incidence, method of abortion and adoption of family planning and outcome. The variables in this study bring into light the social impacts of medical termination of pregnancy. Such study bring into light the awareness of legal services available at the government centers maintaining confidentiality, availability of manpower, resources at free of cost. The absence of complication morbidity and mortality will enlighten the people access to seek legal induced abortion of by the trained persons. Such studies strengthen the family planning programs, reduce the maternal mortality by bring into knowledge of public the safe, effective, legal procedures and maintaining confidentiality.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | medical termination ; pregnancies ; tertiary care centre ; Prospective analytical study. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Punitha K |
| Date Deposited: | 17 Jun 2018 01:23 |
| Last Modified: | 17 Jun 2018 02:47 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8523 |
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